The treatment of invasive pituitary adenoma with termoamine.

Thymosamine is a chemotherapy drug for the treatment of intracranial gliomas.
has also been used since 2006 to treat invasive and malignant pituitary adenomas.
recent studies have shown that the effectiveness of the treatment of invasive pituitary adenomas can reach 70%.
, Ben C Whitelaw of the Endocrinology Department at King's College Hospital in London, UK, and others, on behalf of the European Endocrinology Society (ESE), summarized the evidence, side effects and dosages of the treatment of pituitary adenoma with thymosamine, published in volume 26 of Endocrine-Related Cancer in 2019.
2018, the European Endocrine Society's Clinical Practice Guidelines define invasive pituitary adenomas as adenomas that continue to grow after taking the best clinical treatment.
guidelines suggest that tymoamine is a first-line chemotherapy drug for the treatment of adenomas, but the evidence of adaptation has not been fully clarified.
based on radiology and histological analysis, it is expected that the adenoma can produce invasive growth behavior as an indication of early use of tymoamine.
, but with less experience with the early use of tymoamine, there may be potential disadvantages, which is debatable.
The scope of adaptation for the treatment of pituitary adenomas is mainly: (1) the effectiveness of advanced treatment in patients with resuscitated or metastatic adenomas has been fully demonstrated;
the results of these studies, which pituitary adenomas respond to the treatment of tymoamine? Case analysis showed that functional pituitary adenomas, especially prolactin and corticosteroid adenomas, had a better therapeutic response to tymoamine, while non-functional adenomas had a smaller response to tymoamine.
it has been found from the workings of timoamine and in the treatment experience of GBM that pituitary adenomas with methyl ostrich metastase (MGMT) depletion and normal DNA mismatch repair (MMR) show the best therapeutic response.
but the results of some medical centers are not exactly what was expected.
MGMT initiator methylation status can be used as an indirect evaluation method in gliomas, but not in pituitary adenomas.
, MGMT status in pituitary adenomas requires direct immunologic histification analysis.
are the therapeutic side effects of antithymoamine? The clinical side effects of tymoamine are about 20%, and common symptoms are fatigue, nausea and vomiting, and blood cell reduction disorders such as leumococyte reduction and plate plateboard reduction.
cell reduction is usually temporary and can be alleviated by delaying the chemotherapy cycle or reducing the dose of the drug.
side effects caused by sterone, such as regenerative anemia, acute liver injury and Stevens-Johnson syndrome, are rare.
risk of developing malignancies in the blood system is only one in 10,000.
is the use of tymoamine therapy in the clinical stage? The treatment of pituitary adenoma consists of three clinical stages: (1) the initial stage of treatment, i.e. initial medication, first surgery and subsequent radiotherapy;
(2) the medium-term treatment stage, is the initial treatment after the tumor appears progress or recurrence and requires further treatment, usually secondary surgery or radiotherapy.
(3) The late stage of treatment, i.e. resuscuive therapy, when pituitary adenoma metastatic diffusion or ineffective for multiple operations and radiotherapy, indicates that all conventional treatment has failed, then the use of tymoamine "rescue therapy", can improve the efficacy.
recently, european guidelines for the diagnosis and treatment of invasive pituitary adenomas have used tymoamine as a first-line chemotherapy drug for pituitary cancer.
the European Endocrine Society has recommended the use of tymoxamine for the treatment of malignant lactodenoma in its guidelines for the treatment of prolactic adenomas, calling the use of tymoxamide "the best treatment last but last."
is the clinical application of tymoamine? Thymosamine is an oral drug.
recommended for the 2018 edition of the ESE guidelines is 200mg/m2 per day, 5 days a cycle, 28 days a course of treatment.
blood tests should be performed at each cycle to assess whether there are blood cell reductions or other side effects or toxicity.
if the patient has hemocytosis, the next round of thymosamine may be delayed or the dose reduced.
reaction within 3 months of the treatment of adenoma tymoamine can indicate the final treatment response.
, the treatment response after 3 cycles of evaluation should be repeated with an MRI scan.
if there is clear clinical progress or new symptoms prior to this, you may decide to review or discontinue treatment in advance.
if an MRI scan shows that the disease is stable or responding well, the next treatment cycle will be given, usually recommended for 12 cycles.
ESE guidelines recommend giving at least six cycles of tymoamine therapy.
but in international clinical practice, patients with a well-treated response are more likely to be given 12 or more cycles of treatment, but the evidence for this treatment is insufficient.
clinical practice has also observed that it is often ineffective to re-enable tymoamine after suspension, thus suggesting that the course of clinical continuous use of tymoamine should be long enough, or increase the number of cycles.
the use of antithymoamine in the same time as radiotherapy may produce stronger therapeutic synergies.
conclusions, tymoamine has become the preferred chemotherapy drug for the treatment of advanced pituitary adenoma, with remarkable effect and good patient tolerance.
authors argue that pituitary adenomas exhibit aggressive behavior as a time to treat with tymoamine, without waiting until all treatment options are exhausted as a resuscitation treatment.
there is no evidence that unproven invasive pituitary adenomas can be considered as potential adaptations to tymoamine.
the authors hope to conduct clinical trials of the treatment of tymoazine in patients with pituitary adenomas with this potential adaptation.
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